Healthcare Provider Details

I. General information

NPI: 1427125566
Provider Name (Legal Business Name): RONDI JOY HANSSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43014 260TH ST
EMERY SD
57332-5805
US

IV. Provider business mailing address

43014 260TH ST
EMERY SD
57332-5805
US

V. Phone/Fax

Practice location:
  • Phone: 605-449-4659
  • Fax: 605-449-4659
Mailing address:
  • Phone: 605-449-4659
  • Fax: 605-449-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR026784
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: